A rich lymphatic network exists in the inferior surface of the vocal cord

Abstract

Conservation laryngeal surgery is an increasingly available alternative for the treatment of laryngeal cancer. Understanding anatomy of laryngeal lymph drainage is essential for clinicians to diagnose, grade and surgically manage the laryngeal cancer. Although the lymphatic drainage of the larynx has been extensively studied, few studies revealed the relationship of the lymphatic drainage between various parts of the larynx. The distribution of lymphatic vessels in the inferior surface of the vocal cord also remains unclear. The aim of this study was to investigate the communication of the lymphatic networks between the vocal cord, the supraglottic and subglottic parts of the larynx, paying special attention to the lymphatic drainage of the inferior surface of the vocal cord. Eighteen larynx specimens from 18 fresh fetal cadavers were manually injected with prassion blue solution into the mucosal or submucosal layer of the larynx in order to reveal the lymphatic vessels in the inner larynx. We found that a rich lymphatic network is present in the inferior surface of the vocal cord, and the lymphatic networks in the superior and inferior surfaces of the vocal cord appear as two different patterns. These findings provide an anatomical basis for the design of a partial or conservation laryngeal surgery, particularly when considering the precise resection margin.

Microstructure of the vocal fold in elderly humans

“…Therefore this study clearly demonstrates the presence of lymphatics in the LP in the elderly population and confirms evidence provided by others that the vocal folds do have lymphatic drainage. Liu et al (2006) used fetal VF tissue to show that there is a rich supply of lymphatics on the inferior surface of the VF while comparatively less lymphatic vessels drain the superior VF surface. These lymphatics are described as running parallel to the free margin of the VF, suggesting that they must exit the VF at the anterior and posterior attachments of the VF like the vocal blood vessels (Liu et al, 2006).…”

“…Liu et al (2006) used fetal VF tissue to show that there is a rich supply of lymphatics on the inferior surface of the VF while comparatively less lymphatic vessels drain the superior VF surface. These lymphatics are described as running parallel to the free margin of the VF, suggesting that they must exit the VF at the anterior and posterior attachments of the VF like the vocal blood vessels (Liu et al, 2006). In this study the lymphatics that were observed on the superior VF surface were sectioned longitudinally, indicating that they were running perpendicular to the VF margin.…”

The stratigraphical organisation of the microvascular systems of the porcine vocal folds

“…The orientation of the lymphatic vessels was quite similar to that of the blood vessels: In humans, the lymphatics of the free edge of the vocal fold run in the direction of the fold's long axis, while the lymphatics in the ventricle and in the area of the subglottis run perpendicular to the vocal fold's long axis [18,34,44,45]. In the porcine glottis, the situation is basically the same, but two peculiar findings made the system more special: many lymphatic vessels on the CraF's caudal side, and in the ventricular fundus, and on the CauF's cranial side ran perpendicular to the folds' long axes.…”

“…In the porcine glottis, the situation is basically the same, but two peculiar findings made the system more special: many lymphatic vessels on the CraF's caudal side, and in the ventricular fundus, and on the CauF's cranial side ran perpendicular to the folds' long axes. The direction of lymph drainage -towards the arytenoid region and towards the ventricular fundus in the CraF and CauF -appears to be analogous to that in the human vocal fold [18,34,44,45].…”

“…In the human vocal fold, the lymph vascular system [16,34,[18][19][20][44][45][46][47] and the blood vascular system [23,25,34] have been studied intensively. However, topographical and stratigraphical relations have not been fully considered.…”